Penmeneth House

Penmeneth House is a residential care home. It is registered to provide accommodation and personal care for up to 15 predominantly older people. The service does not provide nursing care. Nursing services are provided by the community nursing team. At the time of the inspection there were 15 people living at the service.

People’s experience of using this service and what we found

People told us they felt safe and were happy with the care they received at Penmeneth House. Comments from people and their relatives included,"The staff are very good people” and “All the staff are lovely and kind”.

People were comfortable in the service and staff provided support at a relaxed pace. During the afternoon of the inspection staff spent time playing games and chatting with people in the communal lounge.

We were somewhat assured that people were protected from infection controls risks. Recent changes to national guidance on the use of masks in care home had been misunderstood. When raised with managers this issue was immediately addressed and mask wearing reintroduced. We have recommended the service ensures all changed to guidance are fully understood before implementation in the service.

People had choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. We have made a recommendation in relation to recording details of DoLS applications made.

Staff were recruited safely and understood their role in ensuring people were protected from harm. There were sufficient staff available to meet people’s support needs. People told us staff responded promptly to request for assistance and call bells were within reach of everyone the service supported.

Medicines were managed safely and risks to people’s health and wellbeing had been identified assessed and mitigated. Were incident or accident occurred reviews had been completed to identify areas of learning or possible improvement.

Staff had the skills necessary to meet people’s needs and referrals for support from healthcare professionals had been made promptly and appropriately.

The service used a digital care planning and recording system which provided staff with clear guidance on how to meet people’s needs. Daily care records had been accurately maintained and information about people communication needs and preferences was available to all staff.

People were supported to maintain relationships that were important to them and encouraged to participate in a range of activities within the service. There was a part time activities coordinator based in the service three days per week and a vehicle available to enable people to access the community or visit places of interest.

Complaints had been appropriately resolved and there were systems in place to ensure people’s needs were met at the end of their lives.

The staff team were well motivated and enjoyed spending time with the people. Current leadership arrangements were appropriate, and the new manager was well supported by the provider’s directors. Relatives told us, “I think it is a well-run, happy home”.

Rating at last inspection

The last rating for this service was requires improvement (Published 6 December 2019.) At this inspection the rating has improved to good.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively. This included checking the provider was meeting COVID-19 vaccination requirements.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Penmeneth House provides accommodation with personal care for up to 14 people. There were 14 predominantly older people using the service at the time of our inspection. The service is an older style property over two floors with a range of communal areas. These included dining spaces and lounges.

People’s experience of using this service and what we found:

The medicines system was not managed effectively. Some medicines records did not tally with what was in stock. Medicines which were handwritten on to medicine administration records were not countersigned by two members of staff to confirm instructions were correct. Medicines that required cold storage were not being monitored and staff were not observing people take all their medicines. Some staff had received training in medicines management. However, it is a concern that the issues as described had not been identified by the management team to ensure ongoing safe practice.

Staff were not always recruited appropriately. For example, suitable references were not always obtained when new staff had previously worked in a caring capacity.

The service was generally managed effectively. However, systems to monitor service delivery were not always satisfactory. For example, medicine audits had not picked up concerns and recommended changes to the system to address the issues found at this inspection.

The provider and registered manager took over the management of Penmeneth House in November 2018. They had implemented new systems, such as care plans and risk assessments. Staff felt the electronic care plan system that was implemented ensured staff knew more clearly how people wished to be supported. Comments included “Systems are better, more organised”.

Staff felt supported by the management team and communication had improved. Comments included, “Love it here, staff nice, management you can raise issues “Staff morale is quite good” and “Things are better. Good management support, more approachable.”

People were positive about the new management. Some people said they would like more communication. Some people felt a residents meeting would be beneficial, so they could all share ideas and suggestions about the service.

One person told us, “All very nice here.” Relatives told us, “Staff are fantastic. They really communicate. They have tried to make it so welcoming and “Nothing is too much trouble.”

People, relatives and staff felt that staffing levels in the service were satisfactory at all times. We observed people receiving prompt support from care staff when required. People said they were happy with the support they received, and they did not have to wait too long.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Any restrictive practices were regularly reviewed to ensure they remained the least restrictive option and were proportionate and necessary.

There were systems and processes in place to monitor the Mental Capacity Act, and associated Deprivation of Liberty Safeguards assessments and records.

Staff had received appropriate training and support to enable them to carry out their roles safely.

The food provided by the service was enjoyed by people.

People told us they enjoyed the opportunity to participate in some activities at Penmeneth house and spent time within the wider community.

People received care and support that was individual to their needs and wishes. Care plans were regularly reviewed and updated and were an accurate reflection of people’s needs and wishes.

The service is an old house that has only has one bathroom. People told us that this could impact on when they chose to have a bath as there was a lack of bathroom facilities. The provider was aware of the impact for people and stated the lack of bathing facilities would be reviewed. We have made a recommendation about this in the effective section of the report.

Risk assessments provided staff with sufficient guidance and direction to provide person-centred care and support.

We observed many kind and caring interactions between staff and people. Staff spent time chatting with people as they moved around the service.

A complaints process and procedure was available to people. The manager told us there were no on-going complaints at the time of this inspection.

The building was clean, and there were appropriate procedures to ensure any infection control risks were minimised.

People were supported to access healthcare services, staff recognised changes in people's health, and sought professional advice appropriately.

People, relatives and staff had confidence in the management of the service.

Rating at last inspection and update:

The last rating for this service was Good (published 27 February 2017) when registered under the provider Mr & Mrs Richards. Since this rating was awarded the provider and registered manager has changed.

Why we inspected:

This was the first planned comprehensive inspection of the service. This service has an overall rating of requires Improvement.

We have found evidence that the provider needs to make improvements. Please see Safe, Effective and Well-led section of the report.

Follow up:

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Enforcement

We have identified breaches in relation to staff recruitment, medicines, quality assurance and governance at this inspection. You can see what action we have asked the provider to take at the end of this full report.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk